Screening for Celiac Disease in Type 1 Diabetics

Type 1 diabetes (T1D) is a chronic, autoimmune disease characterized by the destruction
of the insulin-producing beta cells in the pancreas. T1D is often diagnosed in childhood
and results in a lifelong need for insulin.

Celiac disease (CD), like T1D, is also an autoimmune condition. This autoimmune
disorder is triggered in genetically predisposed people by consuming gluten. Symptoms
of CD include vitamin deficiencies, iron deficiency anemia, failure to thrive, diarrhea,
anorexia, constipation, vomiting, and abdominal discomfort. However, several reports in
the literature state that many cases of CD are asymptomatic or associated with mild
symptoms. Currently, the only effective treatment for CD is a lifelong gluten-free diet
(GFD), which results in resolution for most individuals.

Why do patients with T1D need to consider a concurrent diagnosis of CD? The
prevalence of CD in the general population is quite low at 0.5%. In contrast, studies
published in the last few years have demonstrated elevated prevalence of CD among
individuals with T1D (on average 5%), but may be as high as 10%.

If you are a T1D, a screen for CD is important. Less than 10% of patients with T1D with CD show
gastrointestinal symptoms such as diarrhea, constipation, vomiting, and abdominal
bloating. Therefore, screening is necessary.

The International Society for Pediatric and Adolescent Diabetes recommends screening
for CD at diagnosis of T1DM and then every year in the first five years of follow-up.
The burden of co-existing, yet undiagnosed, CD and T1D may be expected to negatively
affect glycemic control. One study showed that in patients with both T1D and CD who
did not adhere to a GFD had higher HBA1C levels (a useful, long-term gauge of blood
sugar control). Patients with CD who do not adhere to a GFD are at an increased risk of
diabetic retinopathy and atherosclerosis compared to patients without CD and those with
CD who do adhere to a GFD.

If you, or your child, have been diagnosed with T1D, it is important to know whether you
have CD or not. Seek the support of a naturopathic doctor who can screen for CD via
blood work and who can guide your family to eating a GFD while still maintaining good
blood sugar balance. Other pieces of a treatment plan for T1D may include high dose
omega-3 fatty acids and vitamin D3 optimization.

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